الفهرس 
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Abstract
Ultrasound has received increasing interest from chest physicians in recent years. Modern ultrasound devices are inexpensive, portable, lightweight and easy to be used which makes them suitable for outpatient settings as well as bedside investigation of the severely ill patients.
Weaning failure is one of the most frequently encountered events in management of patients receiving mechanical ventilation. Weaning failure attempt substantially prolongs ICU stay, the duration of mechanical ventilation and increases the risk of hospital mortality.
Predicting extubation outcome and preventing extubation failure is therefore an important( task). Various weaning parameters have been suggested to be useful eg: tidal volume (VT), rapid shallow breathing index (RSBI), respiratory rate (RR) and minute ventilation (MV) however the prediction rate of these parameters may not be satisfactory.
The imbalance between respiratory demand and supply will lead to weaning failure through the development of respiratory muscle fatigue, so evaluating the strength of the respiratory muscles becomes very important. Ultrasonography has been shown to be a promising tool in evaluating the diaphragmatic function.
Aim of the study
The purpose of this study is to evaluate real time ultrasound in evaluation of diaphragmatic thickening, diaphragmatic thickness fraction and or excursion to predict extubation outcomes. We also aim to compare these parameters to other traditional weaning measures.
During the study period, we evaluated 162 Patients.
-122 patients evaluated for weaning trial(in respiratory intensive care unit).
-42 cases were excluded. Ten of them had pleural effusion, four cases had pneumothorax, ten cases had signs of neuromuscular diseases and 18 case had non-cooperative or not understanding.
- 40 patients(control) stable COPD in Out Patient Clinic.
- 80 patients divided into
-40 patients (group A) ; With non-pulmonary related cause.
-40 patients (group B); With pulmonary related cause.
As regard weaning from mechanical ventilation, many parameters were used to assess the patients as: respiratory rate (RR), with sensitivity of 55%, specificity of 67% and an AUC 66 %. (RSBI) with sensitivity of 90 %, specificity of 47 % and an AUC 71%. (MV) with sensitivity of 45 %, specificity of 70 % and an AUC 68%.Also the prediction rate of these parameters may not be satisfactory so evaluating the DT, DE and DTF become important, during spontaneous and deep breathing.
In the present study, during tidal breathing DTF%, sensitivity (90%), specificity (75% ) and an AUC ( 77%). Also, DE sensitivity(68%), specificity (65%) and an AUC (73%).
In the present study, during deep breathing DTF, sensitivity(97%), specificity (100%) and an AUC (100%). Also, DE sensitivity (75%), specificity (55%) and an AUC (68%).
Parameters of weaning including TV, RR, RSBI , DE and DTF were significantly betterin successful group than failed group.
Diaphragmatic indices measured by ultrasound is one of the most sensitive, specific and accurate parameters for weaning from mechanical ventilation, especially in relationship with the other weaning parameters as tidal volume, RSBI,
RR and days of mechanical ventilation should be kept in consideration during weaning from mechanical ventilation.
Diaphragmatic indices measured by ultrasound is an accurate technique that has had no technical failures and is relatively easy to master. The modality is portable, which is very important for many seriously ill patients receiving mechanical ventilation. It should be the modality of choice in the examination of motion of the diaphragm.